Public health response and medical management of internal contamination in past radiological or nuclear incidents: A narrative review.

Following a radiological or nuclear emergency, workers, responders and the public may be internally contaminated with radionuclides. Screening, monitoring and assessing any internal contamination and providing necessary medical treatment, especially when a large number of individuals are involved, is challenging. Experience gained and lessons learned from the management of previous incidents would help to identify gaps in knowledge and capabilities on preparedness for and response to radiation emergencies. In this paper, eight large-scale and five workplace radiological and nuclear incidents are reviewed cross 14 technical areas, under the broader topics of emergency preparedness, emergency response and recovery processes. The review findings suggest that 1) new strategies, algorithms and technologies are explored for rapid screening of large populations; 2) exposure assessment and dose estimation in emergency response and dose reconstruction in recovery process are supported by complementary sources of information, including 'citizen science'; 3) surge capacity for monitoring and dose assessment is coordinated through national and international laboratory networks; 4) evidence-based guidelines for medical management and follow-up of internal contamination are urgently needed; 5) mechanisms for international and regional access to medical countermeasures are investigated and implemented; 6) long-term health and medical follow up programs are designed and justified; and 7) capabilities and capacity developed for emergency response are sustained through adequate resource allocation, routine non-emergency use of technical skills in regular exercises, training, and continuous improvement.

Monitoring and Dose Assessment for Children Following a Radiation Emergency Part I: Reference Values for In Vitro Bioassay.

Following a radiation emergency, children may be internally contaminated by the radionuclide(s) involved. Timely assessment of the contamination informs the need for medical treatment for those persons who had significant intakes and reassures those whose intakes are not a medical concern. In vitro bioassay reference values for children of all ICRP age groups are derived for 30 contamination scenario/radionuclide combinations involving 13 radionuclides. These bioassay values are derived from an intake that leads to a 70-y committed effective dose of 50 mSv or a 30-d RBE-weighted absorbed dose to the lungs of 0.2 Gy-Eq, depending on which criterion is more strict. These values are presented in a collection of lookup tables that can be used directly as references.

Managing Internal Radiation Contamination Following an Emergency: Identification of Gaps and Priorities.

Following a radiological or nuclear emergency, first responders and the public may become internally contaminated with radioactive materials, as demonstrated during the Goiânia, Chernobyl and Fukushima accidents. Timely monitoring of the affected populations for potential internal contamination, assessment of radiation dose and the provision of necessary medical treatment are required to minimize the health risks from the contamination. This paper summarizes the guidelines and tools that have been developed, and identifies the gaps and priorities for future projects.